AB0365 PATIENTS WITH RHEUMATOID ARTHRITIS CLASSIFIED AS “HIGH ACTIVITY” ACCORDING TO DAS28 OR CDAI INCLUDE 55% AND 70% WHO SCREEN POSITIVE FOR DEPRESSION AND 67% AND 80% WHO SCREEN POSITIVE FOR FIBROMYALGIA, RESPECTIVELY
Authors: T. Pincus, R. Hunter, N. Rodwell
Journal: Annals of the Rheumatic Diseases (2023)

<h3>Background</h3> No single measure can serve to assess all patients with rheumatoid arthritis (RA), and indices based on a core data set of 7 measures are used in clinical trials and clinical care. Two prominent RA indices are DAS28 (disease activity score 28) and CDAI (clinical disease activity index), which are classified into 4 categories of high, moderate, low disease activity and remission. It has been reported that comorbid fibromyalgia (FM) and depression (DEP) may elevate DAS28 and CDAI values, but systematic comparison of the proportions of patients in different activity categories who screen positive for these comorbidities has not been reported. Feasible screening for FM and DEP is available using MDHAQ (multiple dimensional health assessment questionnaire) FM and DEP indices, which agree more than 80% with reference standards. <h3>Objectives</h3> To analyze the proportion of routine care RA patients who screen positive for FM and DEP according to the 4 DAS28 and CDAI activity categories. <h3>Methods</h3> The 7 RA core data set measures - SJC, TJC, PaGA, PhGA, ESR, CRP, physical function and pain - were collected in unselected RA patients in a cross-sectional study at a routine care visit to an academic site. The patient measures were all collected on an MDHAQ which is completed by all patients and includes physical function, pain, PaGA, fatigue visual numeric scales (VNS), 0-3.3 DEP query, self-report 0-54 patient RADAI painful joint count, 60-symptom checklist including DEP, medical history queries, and FAST4 and MDS2 indices. FAST4 FM screen is positive if 3/4 of: pain VNS ≥6/10, fatigue VNS ≥6/10, self-reported painful joint count ≥16/54, and/or symptom checklist ≥16/60. MDS2 DEP screen is positive if 0-3.3 DEP response is ≥2.2 OR positive DEP on the symptom checklist. DAS28-ESR and CDAI were computed according to standard methods, and patients were classified into 4 activity categories: high (&gt;5.1/28 and &gt;22/76), moderate (3.2-5.1 and 10.1-22), low (2.6-3.2 and 2.9-10), and remission (≤2.6 and 2.8), for DAS28-ESR and CDAI, respectively. The median SJC, TJC, and proportions of FAST4 and MDS2 patients in each category were compared using chi-square analyses. <h3>Results</h3> Among 122 patients, categories of remission, low, moderate, and high activity, respectively, included 44%, 15% 34%, and 7% by DAS28-ESR, and 13%, 31%, 39% and 16% by CDAI. Median SJC was 0, 0, 2 and 4 for DAS28-ESR and 0, 0, 0 and 4 for CDAI categories. Median TJC was 0, 2, 5 and 5 in DAS28-ESR and 0, 1, 3 and 14 in 4 CDAI categories (Table 1). Positive FM FAST4 FM screen was seen in 13%, 22%, 44% and 67% in 4 DAS28-ESR categories and 0%, 2.6%, 38%, and 80% in 4 CDAI categories. Positive DEP MDS2 was seen in 20%, 44%, 46% and 56% in 4 DAS28-ESR categories, and 6%, 24%, 40% and 70% in 4 CDAI categories. <h3>Conclusion</h3> Among RA patients classified as high DAS28-ESR or CDAI "activity", respectively, 55% and 70% screened positive for DEP, 67% and 80% for FM respectively. These phenomena may affect treat-to-target and other aspects of RA management. <h3>REFERENCES:</h3> NIL. <h3>Acknowledgements:</h3> NIL. <h3>Disclosure of Interests</h3> None Declared.